Provider Demographics
NPI:1003888306
Name:MINOR-SCHORK, DEBRA LYNNE (RN MSN CS BC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNNE
Last Name:MINOR-SCHORK
Suffix:
Gender:F
Credentials:RN MSN CS BC
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Other - First Name:
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Mailing Address - Street 1:407 S. BROAD ST. STE. 1
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932
Mailing Address - Country:US
Mailing Address - Phone:252-562-8833
Mailing Address - Fax:252-482-1055
Practice Address - Street 1:407 S. BROAD ST. STE. 1
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932
Practice Address - Country:US
Practice Address - Phone:252-562-8833
Practice Address - Fax:252-482-1055
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC147129-01364SP0808X
NC100093364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890000166OtherRAILROAD MEDICARE
NC1037AOtherBCBS NC
NC6004026Medicaid
NC2596055AMedicare ID - Type Unspecified
NC6004026Medicaid